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Báo cáo y học: " Clinical review: Timing and dose of continuous renal replacement therapy in acute kidney injury"

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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Clinical review: Timing and dose of continuous renal replacement therapy in acute kidney injury...

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Available online http://ccforum.com/content/11/6/232 Review Clinical review: Timing and dose of continuous renal replacement therapy in acute kidney injury Paul M Palevsky Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, and Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA Corresponding author: Paul M Palevsky, palevsky@pitt.edu Published: 6 November 2007 Critical Care 2007, 11:232 (doi:10.1186/cc6121) This article is online at http://ccforum.com/content/11/6/232 © 2007 BioMed Central Ltd. Abstract outcomes of AKI and that optimization of renal support may reduce its high mortality [6-8]. Recent studies have The optimal management of renal replacement therapy (RRT) in suggested that more intensive dosing of both continuous acute kidney injury (AKI) remains uncertain. Although it is well [9,10] and intermittent [11] RRT are associated with accepted that initiation of RRT in patients with progressive azotemia prior to the development of overt uremic manifestations is reductions in mortality; however, results have not been associated with improved survival, whether there is benefit to even consistent across all studies [12] and these findings have not earlier initiation of therapy is uncertain. Although retrospective and been widely applied in clinical practice [13]. Although this observational studies have suggested improved survival with very review focuses on the issue of timing and dose of continuous early initiation of continuous RRT (CRRT), interpretation of these RRT (CRRT), summarizing recent data and suggesting studies is confounded by their failure to include patients with AKI avenues for future research, it should be recognized that who recover renal function or die without ever receiving RRT. Several studies have suggested that more intensive delivery of many of the same issues apply to the management of CRRT during AKI is associated with improved survival, although intermittent hemodialysis in AKI. The related issue of modality results of trials have been inconsistent. Two large multicenter of renal support, the subject of multiple recent studies randomized clinical trials addressing this question are currently [14-17], is beyond the scope of this review, and has been underway and should provide more definitive data within the next reviewed and debated elsewhere [18-22]. two years. Timing of initiation of continuous renal Introduction replacement therapy The optimal management of renal replacement therapy (RRT) Although the focus of this review is on CRRT, a brief in acute kidney injury (AKI) is uncertain. Although supportive summary of data regarding the initiation of intermittent hemo- care with RRT has been the mainstay of treatment of severe dialysis in AKI is informative. The concept of prophylactic AKI for more than five decades, many fundamental aspects of hemodialysis in AKI was introduced by Teschan and RRT management remain controversial, including selection of colleagues more than 50 years ago [23,24]. A series of retro- modality, timing of initiation, and dosing of therapy. In the spective case series and observational studies conducted past, the commonly held view was that patients with from the 1950s through the early 1970s compared ‘early’ advanced renal dysfunction died with, but, so long as acute initiation of hemodialysis, as defined by blood urea nitrogen uremic complications were prevented, did not die of, their (BUN) concentrations ranging from < 93 mg/dl to levels of renal failure. The corollary of this view was that management approximately 150 mg/dl, to ‘late’ initiation of therapy, as of RRT merely needed to assure that patients did not defined by BUN levels of 163 mg/dl to > 200 mg/dl [25-27]. succumb to hyperkalemia, metabolic acidosis, or volume These studies (Table 1) all demonstrated improved survival overload and that overt uremic complications, such as with earlier initiation of hemodialysis. Two prospective clinical pericarditis and encephalopathy, were prevented. However, trials comparing early to late initiation of hemodialysis in AKI studies over the past decade have challenged this paradigm, were conducted during the 1970s and 1980s [28,29]. In the demonstrating that AKI is an independent risk factor for first of these prospective trials, 18 patients with post- mortality [1-5]. An implication of these data is that the traumatic AKI were alternately assigned to an intensive management of RRT may have a critical impact on the dialysis regimen to maintain the pre-dialysis BUN at AKI = acute kidney injury; BUN = blood urea nitrogen; CRRT = continuous RRT; CVVH = continuous venovenous hemofiltration; CVVHDF = con- tinuous venovenous hemodiafiltration; ICU = intensive care unit; IHD = intermittent hemodialysis; RRT = renal replacement therapy. Page 1 of 6 (page number not for citation purposes)
Critical Care Vol 11 No 6 Palevsky Table 1 Summary of studies evaluating the timing of initiation of renal replacement therapy BUN at initiation of RRT (mg/dl) Survival (%) Study Year Mode of RRT Study design N Early Late Early Late Parsons et al. [25] 1961 IHD Retrospective 33 120-150 >200 75 12 Fisher et al. [26] 1966 IHD Retrospective 162 ~150 >200 43 26 Kleinknecht et al. [27] 1972 IHD Retrospective 500 163 73 58 Conger [28] 1975 IHD RCT 18
Available online http://ccforum.com/content/11/6/232 Similar results have been reported in two retrospective variate analysis, the relative risk of death associated with analyses of timing of CRRT in patients following cardiac dialysis initiation with a higher degree of azotemia (using the surgery [32,33]. Demirkiliç and colleagues [32] reported on a ‘early’ initiation group as the comparator) was 1.85 (95% series of 61 patients undergoing cardiac surgery at a single confidence interval 1.16 to 2.96). Similarly, using a center in Turkey between March 1992 and September 2001 propensity score analysis to adjust for factors predicting who received postoperative continuous venovenous hemo- initiation of therapy at a higher compared to a lower BUN, the diafiltration (CVVHDF). In the 27 patients treated before June relative risk in the high BUN group was 2.07 (95% 1996, CVVHDF was started when the serum creatinine level confidence interval 1.30 to 3.29). Combining the multivariate exceeded 5 mg/dl or the serum potassium level exceeded adjustment and the propensity score yielded an adjusted 5.5 mEq/l despite medical therapy, independent of urine relative risk of 1.97 (95% confidence interval 1.21 to 3.20). output (group 1); in the remaining 34 patients treated after June 1996, CVVHDF was initiated if the urine volume was There are several important limitations to all of these less than 100 ml over 8 hours despite administration of retrospective studies. First, in the studies by Gettings and furosemide (group 2). Treatment was initiated 2.6 ± 1.7 days colleagues [31] and Liu and colleagues [35], BUN was used after surgery in group 1 compared to 0.9 ± 0.3 days in group as a surrogate measure for duration of AKI. However, BUN is 2. Early initiation was associated with lower ICU (17.6% an imperfect surrogate for time. Urea generation is not versus 48.1%; p < 0.05) and hospital mortality (23.5% versus constant between patients, or even within an individual 55.5%; p < 0.05) and decreased duration of both mechanical patient over time, and the volume of distribution of urea may ventilation and ICU length of stay. Similarly, Elahi and change over time. As a result, the rate of increase in BUN colleagues [33] identified 64 consecutive patients who varies between patients, and may not even be constant in an underwent cardiac surgery between January 2002 and individual patient over time. Second is the issue of bias by January 2003 in a single center in the United Kingdom and indication. Renal support was initiated for oliguria in the ‘early’ who were treated with post-operative CVVH. In 28 patients, groups and for azotemia or hyperkalemia in the ‘late’ groups CVVH was not initiated until the BUN was at least 84 mg/dl, in both of the post-cardiac surgery studies [32,33]. Although the creatinine was at least 2.8 mg/dl or the serum potassium the reasons for ‘early’ and ‘late’ initiation of treatment in the was greater than 6 mEq/l despite medical therapy, regardless studies by Gettings and colleagues [31] and Liu and of urine output (group 1), while in the remaining 36 patients colleagues [35] were not specified, it is likely earlier initiation CVVH was initiated if the urine volume was less than 100 ml was prompted by volume overload and electrolyte over 8 hours despite furosemide infusion (group 2). As in the disturbances whereas late initiation of therapy was more likely prior study, the reported demographic and baseline clinical to be prompted by progressive azotemia. Whether there is a characteristics of the two groups were similar. The interval relationship between indication for therapy and outcome is between surgery and initiation of renal support was 2.6 ± 2.2 not known. Most importantly, the design of all four of these days in group 1 compared to 0.8 ± 0.2 days in group 2. studies limited analysis to patients who received renal Hospital mortality was 43% in group 1 and 22% in group 2 replacement therapy, ignoring the subset of patients with AKI (p < 0.05). Similar results have been reported by Piccinni and who recover or die without RRT. colleagues [34] in an analysis of 40 consecutive oliguric patients with sepsis treated with early isovolemic hemo- A single study has attempted to address the timing of CRRT filtration compared to 40 consecutive historical controls. prospectively. Bouman and colleagues [12] randomized 106 Twenty-eight day survival in the patients treated with critically ill patients with AKI at two centers to three groups: isovolemic hemofiltration was 55% compared to 27.5% in the early high-volume CVVH (n = 35), early low-volume CVVH historical control cohort. (n = 35) and late low-volume CVVH (n = 36). Treatment was initiated in the two early groups within 12 hours of meeting In another retrospective analysis, Liu and colleagues [35] study inclusion criteria, which included the presence of analyzed data on the timing of initiation of renal replacement oliguria for more than 6 hours despite hemodynamic optimiza- therapy (both intermittent hemodialysis (IHD) and CRRT) tion or a measured creatinine clearance of less than from the Program to Improve Care in Acute Renal Disease 20 ml/minute on a 3 hour timed urine collection. In the late (PICARD), a multicenter observational study of AKI. The 243 group, renal support was not initiated until the BUN was more patients in the database who received RRT were stratified than 112 mg/dl, potassium was more than 6.5 mEq/l, or into ‘early’ and ‘late’ initiation groups based on the median pulmonary edema was present. No significant differences in BUN (76 mg/dl) at initiation of therapy. Although patients in survival were observed between the three groups. Of note, the ‘late’ (BUN > 76 mg/dl) group had a reduced burden of however, the overall 28 day mortality for subjects in this study organ failure, the survival rates at 14 days and 28 days in this was only 27%, substantially lower than mortality rates group (0.75 and 0.59, respectively) were slightly lower than reported in most other studies of critically ill patients with AKI, in the ‘early’ (BUN ≤ 76 mg/dl) group (0.8 and 0.65, suggesting a lower disease burden in this cohort. In addition, respectively). After adjustment for age and clinical factors and as a result of the small sample size, the statistical power of stratification by site and initial modality of RRT in a multi- the study was low, meaning that there is a high likelihood of Page 3 of 6 (page number not for citation purposes)
Critical Care Vol 11 No 6 Palevsky Table 2 Summary of studies evaluating the dose of continuous renal replacement therapy Effluent flow rate (ml/kg/h) Survival (percent) Study Year N Low dose High dose Low dose High dose Ronco et al. [9] 2000 435 20 35 41 57 45 58 Bouman et al. [12] 2002 106 19 48 72 74 Saudan et al. [10] 2006 206 25 42 39 59 type II error. It is also important to note that 6 of the 36 of renal function between groups, with greater than 90% of patients (16.7%) in the late therapy group never received surviving patients having full recovery of renal function RRT, 2 patients because they died prior to meeting criteria 15 days after discontinuation of CRRT; among non-survivors, for RRT and 4 patients because they recovered renal approximately 20% of patients had recovered renal function function. at time of death. Thus, current data remain inadequate to answer the question In contrast, Bouman and colleagues [12] observed no of appropriate indications and timing of initiation of CRRT in improvement in survival with high volume hemofiltration (3 l/h; AKI. The vast majority of patients with AKI are never treated median, 48 ml/kg/h)) compared to low volume hemofiltration with RRT, yet have increased mortality rates [36]. Whether (1 to 1.5 l/h; median, 19 ml/kg/h) in their previously described earlier initiation of RRT, regardless of modality, or provision of study of 106 subjects randomized to early high-volume, early therapy in patients currently managed conservatively, low-volume or late low-volume CVVH. However, as previously improves survival remains an open question. Would this noted, with 106 patients divided between three treatment strategy improve outcomes, or does the observational data arms, the negative result does not have sufficient statistical suggesting improved outcomes merely reflect inclusion of power to demonstrate equivalence. patients with a lesser degree of organ injury, whose out- comes would be better regardless of treatment strategy? More recently, Saudan and colleagues [10] reported the Ultimately, the answer will require data from a prospective results of a single center randomized trial comparing CVVH randomized trial. However, the design of such a trial poses (n = 102) with a mean ultrafiltration rate of 25 ± 5 ml/kg/h to significant challenges; most critically, the need for early CVVHDF (n = 104) with a mean total effluent flow rate of identification of patients who will have persistent and severe 42 ml/kg/h (mean ultrafiltration rate of 24 ± 6 ml/kg/h; mean renal injury. Without reliable markers to identify this dialysate flow rate of 15 ± 5 ml/kg/h). Survival after 28 days population, a substantial number of patients who would not was 39% in the CVVH group and 59% in the CVVHDF otherwise be started on RRT will need to be randomized into (p = 0.03) and 34% and 59%, respectively, after 90 days an early therapy arm and subjected to the risks of RRT. Thus, (p = 0.0005). Recovery of renal function was not different robust biomarkers and/or clinical predictors of the course of between the two groups, with 71% of surviving patients AKI are needed before such a study can be undertaken. recovering renal function by day 90 in the CVVH group compared to 78% in the CVVHDF group. Although on Dose of continuous renal replacement therapy superficial consideration this study might be interpreted as a Three randomized controlled trials have assessed the comparison of modality of CRRT, it is more appropriate to relationship between dose of CRRT and outcomes of AKI consider it as a dosing study. In the CVVHDF group, diffusive (Table 2) [9,10,12]. Since the clearance of low molecular clearance was added to an essentially constant dose of weight solutes during CRRT closely approximates total hemofiltration, increasing total effluent flow rate by more than effluent flow, the dose of therapy can be quantified in terms of 70%. For this to have been a pure comparison of modality, the sum of the ultrafiltrate and dialysate flow rates. Ronco and without influence of dose, the total effluent flow rate in the colleagues [9] randomized 425 critically ill patients with AKI two treatment arms would have needed to be constant. treated using CVVH at a single center to ultrafiltration rates of Rather, this study suggests that augmentation of small solute 20, 35 or 45 ml/kg/h. Survival 15 days after discontinuation clearance is associated with improved survival. As with other of CRRT was 41% in the lowest dose arm compared to 57% single center studies, the results of this study should be and 58% in the intermediate and highest dose arms, interpreted with caution, particularly since the investigators respectively (p < 0.001). There was no difference in recovery were not blinded to treatment group assignment. Page 4 of 6 (page number not for citation purposes)
Available online http://ccforum.com/content/11/6/232 Several studies have suggested benefit with even higher trials have suggested an improvement in survival with higher doses of convective therapy (for example, high volume hemo- doses of CRRT, results have not been consistent across all filtration) in patients with sepsis [9,37,38]. These investi- studies. Two large randomized clinical trials are currently gators have postulated that removal of humoral mediators underway that should provide high quality evidence regarding modulate the inflammatory response in patients with severe the optimal dosing of renal support in AKI. sepsis. The data from these studies are not sufficiently Competing interests robust, however, to draw any definitive conclusions. PMP is the Study Chairman of the VA/NIH Acute Renal Two large multicenter randomized controlled trials addressing Failure Trial Network Study. He declares that he has no other intensity of renal support in AKI are currently under way competing interests. [39,40]. In the United States, the VA/NIH Acute Renal Failure References Trial Network (ATN) Study comparing two strategies for the 1. Levy EM, Viscoli CM, Horwitz RI: The effect of acute renal intensity of renal support recently concluded subject failure on mortality. A cohort analysis. JAMA 1996, 275:1489- enrollment [39,40]. In both treatment arms, patients received 1494. 2. Bates DW, Su L, Yu DT, Chertow GM, Seger DL, Gomes DR, IHD when they were hemodynamically stable and either Platt R: Correlates of acute renal failure in patients receiving CVVHDF or sustained low-efficiency dialysis (SLED) when parenteral amphotericin B. Kidney Int 2001, 60:1452-1459. they were hemodynamically unstable. In the intensive therapy 3. Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J: Independent association between acute renal failure and arm, IHD and SLED were provided six-times per week and mortality following cardiac surgery. Am J Med 1998, 104:343- CVVHDF at a total effluent flow rate of 35 ml/kg/h. In the low- 348. dose arm, IHD and SLED were provided three-times per 4. Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, Le Gall JR, Druml W: Effect of acute renal failure requiring renal week and the effluent flow during CVVHDF was 20 ml/kg/h. replacement therapy on outcome in critically ill patients. Crit With an enrollment of 1,124 patients, the ATN study has Care Med 2002, 30:2051-2058. 5. Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW: > 90% power to detect a reduction in mortality from 55% to Acute kidney injury, mortality, length of stay, and costs in hos- 45% at a two-sided significance level of 0.05. In Australia pitalized patients. J Am Soc Nephrol 2005, 16:3365-3370. and New Zealand, the Randomized Evaluation of Normal 6. Liano F, Junco E, Pascual J, Madero R, Verde E: The spectrum of acute renal failure in the intensive care unit compared with versus Augmented Level of RRT (RENAL) study is that seen in other settings. The Madrid Acute Renal Failure randomizing patients treated with CVVHDF to effluent flow Study Group. Kidney Int Suppl 1998, 66:S16-24. 7. Liano F, Pascual J: Epidemiology of acute renal failure: a rates of either 25 or 40 ml/kg/h [40]. The RENAL study will prospective, multicenter, community-based study. Madrid randomize 1,500 patients, providing 90% power to detect a Acute Renal Failure Study Group. Kidney Int 1996, 50:811- reduction in mortality from 60% to 51.5% with a two-sided 818. 8. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera significance level of 0.05. It is scheduled to conclude S, Schetz M, Tan I, Bouman C, Macedo E, et al.: Acute renal enrollment in late 2007 or early 2008. When completed, failure in critically ill patients: a multinational, multicenter study. JAMA 2005, 294:813-818. these two studies should provide high quality evidence 9. Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, regarding dosing strategies for renal support in AKI. La Greca G: Effects of different doses in continuous veno- venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 2000, 356:26-30. Conclusion 10. Saudan P, Niederberger M, De Seigneux S, Romand J, Pugin J, The optimal timing for initiation of RRT in patients with AKI is Perneger T, Martin PY: Adding a dialysis dose to continuous uncertain. Although several observational and retrospective hemofiltration increases survival in patients with acute renal failure. Kidney Int 2006, 70:1312-1317. analyses have suggested improved survival with earlier 11. Schiffl H, Lang SM, Fischer R: Daily hemodialysis and the out- initiation of renal support, the exclusion of patients with AKI come of acute renal failure. N Engl J Med 2002, 346:305-310. 12. Bouman CS, Oudemans-Van Straaten HM, Tijssen JG, Zandstra who meet criteria for early initiation of RRT but never receive DF, Kesecioglu J: Effects of early high-volume continuous ven- therapy limits the validity of these analyses. Unfortunately, ovenous hemofiltration on survival and recovery of renal func- however, this question will probably not be able to be tion in intensive care patients with acute renal failure: a prospective, randomized trial. Crit Care Med 2002, 30:2205- definitively answered in a prospective randomized controlled 2211. trial until more robust biomarkers and/or clinical predictors of 13. Overberger P, Pesecreta M, Palevsky P: Management of renal replacement therapy in acute kidney injury: A survey of practi- the course of AKI are available. Although multiple clinical tioner prescribing practices. Clin J Am Soc Nephrol 2007, 2:in press. 14. Mehta RL, McDonald B, Gabbai FB, Pahl M, Pascual MT, Farkas A, Kaplan RM: A randomized clinical trial of continuous versus This article is part of a review series on intermittent dialysis for acute renal failure. Kidney Int 2001, Renal replacement therapy, 60:1154-1163. 15. Augustine JJ, Sandy D, Seifert TH, Paganini EP: A randomized edited by John Kellum and Lui Forni. controlled trial comparing intermittent with continuous dialy- sis in patients with ARF. Am J Kidney Dis 2004, 44:1000-1007. Other articles in the series can be found online at 16. Uehlinger DE, Jakob SM, Ferrari P, Eichelberger M, Huynh-Do U, Marti HP, Mohaupt MG, Vogt B, Rothen HU, Regli B, et al.: Com- http://ccforum.com/articles/ parison of continuous and intermittent renal replacement theme-series.asp?series=CC_Renal therapy for acute renal failure. Nephrol Dial Transplant 2005, 20:1630-1637. Page 5 of 6 (page number not for citation purposes)
Critical Care Vol 11 No 6 Palevsky 17. Vinsonneau C, Camus C, Combes A, Costa de Beauregard MA, 39. Palevsky PM, O’Connor T, Zhang JH, Star RA, Smith MW: Klouche K, Boulain T, Pallot JL, Chiche JD, Taupin P, Landais P, Design of the VA/NIH Acute Renal Failure Trial Network (ATN) Dhainaut JF: Continuous venovenous haemodiafiltration Study: intensive versus conventional renal support in acute versus intermittent haemodialysis for acute renal failure in renal failure. Clin Trials 2005, 2:423-435. patients with multiple-organ dysfunction syndrome: a multi- 40. Bellomo R: Do we know the optimal dose for renal replace- centre randomised trial. Lancet 2006, 368:379-385. ment therapy in the intensive care unit? Kidney Int 2006, 70: 18. Kellum J, Palevsky PM: Renal support in acute kidney injury. 1202-1204. Lancet 2006, 368:344-345. 19. Palevsky PM: Dialysis modality and dosing strategy in acute renal failure. Semin Dial 2006, 19:165-170. 20. Rondon-Berrios H, Palevsky PM: Treatment of acute kidney injury: an update on the management of renal replacement therapy. Curr Opin Nephrol Hypertens 2007, 16:64-70. 21. Ronco C: Continuous dialysis is superior to intermittent dialy- sis in acute kidney injury of the critically ill patient. Nat Clin Pract Nephrol 2007, 3:118-119. 22. Himmelfarb J: Continuous dialysis is not superior to intermit- tent dialysis in acute kidney injury of the critically ill patient. Nat Clin Pract Nephrol 2007, 3:120-121. 23. Teschan P, Baxter C, O’Brian T, Freyhof J, Hall W: Prophylactic hemodialysis in the treatment of actue renal failure. Ann Intern Med 1960, 53:992-1016. 24. Teschan PE: Acute renal failure during the Korean War. Ren Fail 1992, 14:237-239. 25. Parsons FM, Hobson SM, Blagg CR, Mc CB: Optimum time for dialysis in acute reversible renal failure. Description and value of an improved dialyser with large surface area. Lancet 1961, 1:129-134. 26. Fischer RP, Griffen WO Jr, Reiser M, Clark DS: Early dialysis in the treatment of acute renal failure. Surg Gynecol Obstet 1966, 123:1019-1023. 27. Kleinknecht D, Jungers P, Chanard J, Barbanel C, Ganeval D: Uremic and non-uremic complications in acute renal failure: Evaluation of early and frequent dialysis on prognosis. Kidney Int 1972, 1:190-196. 28. Conger JD: A controlled evaluation of prophylactic dialysis in post-traumatic acute renal failure. J Trauma 1975, 15:1056- 1063. 29. Gillum DM, Dixon BS, Yanover MJ, Kelleher SP, Shapiro MD, Benedetti RG, Dillingham MA, Paller MS, Goldberg JP, Tomford RC, et al.: The role of intensive dialysis in acute renal failure. Clin Nephrol 1986, 25:249-255. 30. Conger J: Does hemodialysis delay recovery from acute renal failure. Semin Dial 1990, 3:146-148. 31. Gettings LG, Reynolds HN, Scalea T: Outcome in post-trau- matic acute renal failure when continuous renal replacement therapy is applied early versus late. Intensive Care Med 1999, 25:805-813. 32. Demirkilic U, Kuralay E, Yenicesu M, Caglar K, Oz BS, Cingoz F, Gunay C, Yildirim V, Ceylan S, Arslan M, et al.: Timing of replacement therapy for acute renal failure after cardiac surgery. J Card Surg 2004, 19:17-20. 33. Elahi MM, Lim MY, Joseph RN, Dhannapuneni RR, Spyt TJ: Early hemofiltration improves survival in post-cardiotomy patients with acute renal failure. Eur J Cardiothorac Surg 2004, 26: 1027-1031. 34. Piccinni P, Dan M, Barbacini S, Carraro R, Lieta E, Marafon S, Zamperetti N, Brendolan A, D’Intini V, Tetta C, et al.: Early iso- volaemic haemofiltration in oliguric patients with septic shock. Intensive Care Med 2006, 32:80-86. 35. Liu KD, Himmelfarb J, Paganini E, Ikizler TA, Soroko SH, Mehta RL, Chertow GM: Timing of initiation of dialysis in critically ill patients with acute kidney injury. Clin J Am Soc Nephrol 2006, 1:915-919. 36. Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA: RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006, 10:R73. 37. Honore PM, Jamez J, Wauthier M, Lee PA, Dugernier T, Pirenne B, Hanique G, Matson JR: Prospective evaluation of short-term, high-volume isovolemic hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock. Crit Care Med 2000, 28: 3581-3587. 38. Cole L, Bellomo R, Journois D, Davenport P, Baldwin I, Tipping P: High-volume haemofiltration in human septic shock. Intensive Care Med 2001, 27:978-986. Page 6 of 6 (page number not for citation purposes)

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